Pg. P.U. 5/2000 MARRIAGE, DIVORCE AND RUJU' (STATE OF PENANG)
RULES 2000
FIRST SCHEDULE (Form 12)
FORM 12
(Rule 12)
APPLICATION FOR REGISTRATION OF DIVORCE
Registrar,
Marriage, Divorce and Ruju'
District of ....................................................
State of Penang
I ...............................................................................................................................................................................
Apply to register the divorce which has been certified by Court as follows:
Date : .............................................................................................................................................................
Time : .............................................................................................................................................................
Place : .............................................................................................................................................................
Enclosed herewith are the copy of Syariah Court Order and the details of the divorce (Annexture A) for your further action.
Yours Faithfully,
...................................................... Signature of Applicant
Date: ...........................................
ANNEXTURE A
Marriage Certificate No. .........................................................................................................................................
Name of Husband ........................................................................ I.C. No. ............................................................
Age ..................................................... Occupation ...................................................................................................
Name of Wife .................................................................................. I.C. No. ............................................................
Age ..................................................... Occupation ...................................................................................................
Date of Marriage ........................................................................................................................................................
Name of Witness (1) ....................................................................... I.C. No. ..........................................................
Name of Witness (2) ....................................................................... I.C. No. ..........................................................
Mode of divorce ............................................................ Talak ............................... Lafaz ......................................
Payment of tebus talak (if any) .............................................................................................................................
Place of divorce ............................................................................... Date of divorce .............................................
Divorce in suci/menstruation/pregnant* .............................................................................................................
Nafkah in eddah .....................................................................................................................................................
Nafkah of children ...................................................................................................................................................
Settlement of property, etc. .....................................................................................................................................